Autism, Aspergers & Sensory Integration: Unraveling the Mystery

Autism, Aspergers & Sensory Integration:
Unraveling the Mystery
Aaron Wiemeier MS LPC
June 22, 2013
Statistics
1) 10 years ago Autism was considered a rare disorder
affecting 1 in 10k children – 2002 1:150 – 2013 1:50
(according to CDC)
2) Recent studies have estimated that the lifetime cost to
care for an individual with an ASD is $3.2 million.
3) ASDs are reported to occur in all racial, ethnic, and
socioeconomic groups, yet are on average 4 to 5 times
more likely to occur in boys than in girls
4) In comparing autism to Aspergers in terms of
prevalence, the ratio is about 5:1.
5) 10 – 17% annual growth
6) Cost of lifelong care can be reduced by 2/3 with early
diagnosis and intervention
Myths
Autism
&
Truths
•
Most Autistic people are like the
movie character Raymond Babbott
(Dustin Hoffman) in the movie Rain
Man
All autistic people are very different from
one another finding common ground
only on difficulty with social
communication (AS’D’s)
•
Autistic persons cannot show love or
empathy towards others
Many autistic people show love and
empathy but may do it in
idiosyncratic ways
•
Children with autism can’t make
friends
•
Autistic persons are dangerous
Autistic people can act out in angry ways
due to sensory overload/frustration
etc. but not out of malice
•
All autistic are savants
Majority of autistics have average to
ordinary skill sets. There are only 10
known savants in the world today
•
Autistic people are non-verbal
Many autistic people have very solid
friendships with others and can even
marry and have satisfying romantic
relationships
Classic autism sees more nonverbal
process but many more have
exceptional language abilities (this
type of autism is being diagnosed at
much faster rate than classic)
Autism Defined
Autism – Autism Spectrum Disorders (ASD’s)  range of
neurological/neurodevelopmental disorders characterized
primarily by :
1) social impairments (mis/misperceive nonverbal body cues
from others) i.e poor eye contact, fail to respond to name, poor
empathy (cant extrapolate what others are thinking because
don’t look or understand others facial cues)
2) communication difficulties – also varies in severity from
nonverbal to milder impairments, may refer to self in third
person, speech delays
3) restricted, repetitive & stereotyped patterns of behavior
– vary in severity from repetitive obsessive play to head
banging, rocking, twirling biting etc.
Other Autism Characteristics
• Boys 4x as likely to have autism
• Rise in incidence debate?
 the rise is due to greater public awareness of
the diagnosis, greater funding opportunities
for kids with diagnosis, a widening of criteria
(i.e. ASD’s 1990)
 Many scholars caution that within the above
finding, a true smaller increase may exist in
the incidence of autism
Autism Symptoms
Early Childhood
•
Later Childhood
No babbling or pointing by
•
Impaired ability to make friends
age 1
•
Impaired ability to initiate or sustain
conversation
•
No single words by 16 months or
2 word phrases by age 2
•
Absence or impairment of social or
imaginative play
•
No response to name
•
•
Loss of language (which may be
linked to neurological slow down)
Stereotyped, repetitive or use of
unusual language
•
Restricted areas of interest/abnormal
intensity or focus
•
Preoccupation with certain objects or
subjects
•
Inflexibility with regard to routine
change
•
Poor eye contact
•
Excessive lining up of toys or
objects
•
No smiling or social
responsiveness
Aspergers Disorder
- subset of Autism (DSM 5 may remove this as
separated from autism?)
- language impairment less or non existent –
other 2 traits are
- may have high IQ
- specific traits like memory for certain things may
be accentuated or superior
Famous People who may have
had Aspergers
Organization Of Autism
Pervasive
Developmental
Disorders
Autism
Aspergers
PDD-NOS
Childhood
Disintegrative
Disorder
Rett’s Disease
3 Impairment Criteria That
Determine Severity
Speech
Repetitive
Social
Neurological Implications
•
Brain growth  rapidly in first year then decreases significantly
(brains are average size or smaller after major areas of
development occur)
•
Changes in brain don’t arise after birth but rather the
developmental template is being set neurologically in 1st 2
trimesters in life
•
Major Impacted areas – forebrain/limbic system (actually larger
but nerve cells smaller)(larger amygdala but less white matter
b/w this and frontal lobe) , cerebellum, language center
•
Voices may not trigger reward center of brain in children with
ASD (Abrams et al, 2013)
•
Brain imaging study reveals individuals with autism have a
ticker cortex with more folds. This suggests that differences in
cognitive abilities of people with autism could be due to unique
brain structures. (Doyle et al, 2013)
White and Dark Matter?
Suspected Causes
•
Genetic predisposition
•
Environmental factor (epigenetics)
•
Combo of genetic and environment
•
Vaccines/ pesticides/chemicals/diet
•
increasingly stressful world and exposure to it – how does stress affect
neurological development?
•
Functional Disconnection Syndrome (one side maturing slower than the
other causing imbalances and thus poor communication neurologically)
•
Prenatal Environment
•
Infectious Processes (Maternal Antibody theory)
Sensory Processing Disorder
• Definition – dysynchronous action of nervous
system (road highway analogy)
 (ability to attend to, discriminate and filter out sensory
information of the 5(7) senses (touch taste vision,
hearing, smell) plus movement/position in space –
proprioception
 Hyper/Hypo  Sensory Seeker/Avoider
 Sensory integration refers to ability to take info from env. ,
interpret it in brain and formulate a plan of action (kerstein
2008)
 High Comorbidity with ADHD
Sensory Processing Disorder
Sensory Info
In
Nerves Fire
(Hypo/Hyper)
Child Acts
Out
Amygdala
Processing
Lack Of
Engagement
Forebrain
Sensory Processing Disorder
Sense
Hyper
Hypo
Tactile (touch )  skin
Dislike getting hands
dirty/certain clothes
Messy /Tshirts in
Winter/Touches
everything
Taste  tongue(smell)
Picky eater
Lick/tast/chew inedible
objects
Smell  nose
Pregnancy Effect
Drink Old Milk
Auditory  ears
Headphones (cover
ears)
Makes noise for noises
sake – don’t respond to
name
Vision  Eyes
Light Sensitivities/freq
headaches
Difficulty locating
items/loses place when
reading
Vestibular(balance)
inner ear
Avoids
playground/sedentary
Constant motion/risk
taker
Proprioception (body
awareness) 
muscles/joints
Uncomfortable with
certain movements –
cant calm easily after
exercise
Stomps feet when
walking/freq falls on
floor/hits pushes other
kids
Autism & SPD’s
•
SPD doesn’t typically have social delays/repetitive
movements/language issues outside of whats created from their bx in
handling sensory info
•
ASD’s typically do have some elements of SPD’s
SPD
Language Issues
Autism
Sensory Issues
Aspergers
Trauma & SPD’s
• PTSD hyperarousal (on alert) more as related
to non declarative element of trauma = SPD
issues
• Avoidant element similar to sensory avoider
• Hyperarousal may be associated with increased
intensity as well as duration
• PSTD symptom is often SPD issues  Most
with PTSD have SPD but may not be true in the
opposite direction
ASD’s & SPD’s Treatment
Beliefs/Guilt/Depression/
Loss
Early Intervention &
Detection
Systemic
Treatment
genetics
Environment
Systemic Treatment
Family
Legal
School
Child
Funding
Therapy
ASD’s & SPD’s Treatment
Notes
•
Early Intervention improves
prognosis dramatically
•
Respond well to highly
structured programs
•
On the whole visual cuing
in very helpful in most contexts
•
Types
Assessment
Speech/OT/PT/Sensory
Diet
Medication
Mental health
(CBT/Neuro/EMO
Reg/BX Mod
Experiential
Important not to enable
victim side of person – balance re:
this crucial
Treatment Continued – Autism/Aspergers
1) Applied Behavioral Analysis – structured intensive
program that uses principles of learning theory (i.e.
reinforcement) to reduce behavioral impediments and
increase use of desirable behaviors
• Most people have distorted view of learning theory (i.e
whining Billy)
• In schools ratio affects results
• Intensity of parents participation and follow through
affects results
• Funding Issues?
Treatment Continued – Autism/Aspergers
2) Dietary – theory that food allergies/ vitamin deficiencies can cause symptoms of
autism
i.e. casein (protein in milk) /gluten  casein/gluten free diet
Vitamin B6/B12 supplements taken with magnesium  some parents feel has
positive results(results of research studies are mixed)
3) Medications – meant to reduce symptoms that interfere with learning
- relationship b/w psyc doc and parents
- side effects
- least restrictive t
4) Neuro Based Treatments – Brain Balance – Brain Gym –
5) Experiential Tx
6) OT/PT/Speech Therapy/Emotional Regulation/Nonverbal Body Awareness/Sensory
Integration Tx
Important Note!!!!
• Caution: Here’s a checklist to help figure out if
an autism treatment, or indeed any medical
treatment, is probably too good to be true:
• It treats more than one condition.
• It provides dramatic, miraculous results.
• Anecdotes are offered as proof of its effectiveness, rather
than scientific results in large, peer-reviewed journals.
• Specific treatment goals are not identified. The treatment
said to have no risks or side effects. (All treatments do.)
• It’s the only treatment that’s effective and doesn’t mention
the need for systemic treatment in some context
Sensory Processing Disorders
• Multidisciplinary team
• Family Centered
• Experiential
• Predominant goal to create through play and
activity a more synchronous experiencing
neurologically of sensory information and its
subsequent behavioral response
Sensory Processing Disorders
Occupational Therapy (with SI approach) Occupational therapists (OTs) who are trained
in sensory techniques will engage a child in
playful activities designed to help him/her
process the information he receives from his
senses in a more typical manner.
- Sensory Diet – “menu” of activities to do with
child
Treatment Tool Box
My Feelings Workbook: Teaching Nonverbal Body Awareness
The Brain & Trauma
Tool Box: SPD’s Plus (Kerstein 2011)
1. Have mints and gum with you. These can provide input as well as
assist a person who is sensitive to smells.
2. Put a hand towel in the bath or shower instead of a wash cloth. A wet
hand towel can be heavy and provide proprioceptive input.
3. Have your child help transfer the wet laundry from the washing
machine to the dryer. Again, wet laundry is a nice, natural way to get
input.
4. Assign your child the task of removing the jug of milk or juice from the
refrigerator each morning. This can provide some “heavy work” in a
quick, easy way.
5. Give your younger children access to sand and buckets they can fill
and lift.
6. Provide access to play doh.
7. Take family walks each day for about 10 minutes or so.
8. Drop everything and do wall push-ups 1-2 times per day. Make it fun
and do it together.
9. Have your child help you water the outside plants. Heavy watering
cans provide wonderful input.
10. Give lots and lots of hugs if your child likes them or have a cool high
five “hug” you do throughout the day.
Tool Box: SPD’s Plus (Kerstein 2011)
11. Create a box of “fidgets” and keep it in a prominent location in your
house. Your child can play with those fidgets to get input.
12. Provide crunchy or chewy snacks. Input into our jaw can be very
powerful.
13. Offer a quiet place for your child to go if he/she seems
overstimulated. You can decide on this place together and give it a
special name such as a “tree house”.
14. If your child enjoys his/her “tree house”, it would be helpful to
establish a “tree house” everywhere you go. If you go to your child’s
grandparents’ house, for example, you can look around the house
together for a special “tree house” in case your child needs to take a
break.
15. Carry an MP3 player with you or just headphones. Your child can
put the headphones in his/her ears if he/she is distressed by sounds. If
you have an MP3 player with you, your child can listen to that as a way
to regulate his/her body.
Lauren H. Kerstein, LCSW
8/16/2011http://www.autismspot.com/blog/Fifteen-PracticalSensory-Strategies-Lauren-H-Kerstein-LCSW
Sources-Resources & Recommended Books
Autism
Autism Society of Colorado – http://www.autismcolorado.org/
phone: 720.214.0794
Aspergers
http://www.tonyattwood.com.au
Sensory Integration
http://www.spdfoundation.net
http://www.sensory-processing-disorder.com
Recommended Books
101 Games and Activities for Children With Autism, Asperger’s and Sensory Processing Disorders
The Complete Guide To Aspergers Syndrome – Tony Attwood
Out of Sync Child - Carol Stock Kranowitz
My Sensory Book – Lauren Kerstein
My Feelings Workbook – Aaron Wiemeier
Sources
www.ncbi.nlm.nih.gov
http://www.nimh.nih.gov/health/topics/autism-spectrum-disorders-pervasive-developmentaldisorders/index.shtml
My Sensory Workbook – Kerstein 2008
Melillo, Robert (2009) Disconnected Kids